Treatment patterns and direct medical costs of metastatic colorectal cancer patients: a retrospective study of electronic medical records from urban China
Treatment patterns and direct medical costs of metastatic colorectal cancer patients: a retrospective study of electronic medical records from urban China
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DOI：
10.1080/13696998.2020.1717500
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发表时间：
2020-02-07
影响因子：
2.4
通讯作者：
Xu, Ruihua
中科院分区：
文献类型：
--
作者：
Shen, Lin;Li, Qi;Xu, Ruihua
目的：描述中国转移性结直肠癌（mCRC）患者与每种治疗线相关的直接医疗费用。研究方法：从中国12家三级医院提取了2011年至2016年期间的电子病历，这些患者在数据收集结束前至少9个月开始三线治疗。直接医疗费用包括病房、诊断化验、外科手术、特殊材料、药品和其他费用。按治疗线评估成本，并进一步细分接受单独化疗和接受化疗和生物制剂联合治疗的患者的药物成本。结果：在404例mCRC患者中，平均年龄为55岁，62%为男性。奥沙利铂和伊立替康方案分别占一线和二线治疗的主导地位（44%和37%）。从一线到二线再到三线，接受靶向生物制剂的患者比例从一线的18%和二线的12%增加到三线的34%;中位治疗周期数从6个减少到4个和2个。相应的每人每周期平均直接医疗费用从2 514美元增至2 678美元和5 121美元。在单独接受化疗的患者中，每个周期的平均药物费用从2，314美元增加到2，673美元再到4，316美元，在接受化疗和生物制剂联合治疗的患者中，从3，245美元增加到2，717美元再到6，533美元。结论：在2017年之前，中国的mCRC患者并未获得精准医学突破的最大益处。从一线到三线的治疗周期减少和每个周期费用增加表明医疗资源利用率低下。随着更早的开始和更多的治疗周期，靶向生物制剂可能会更好地证明其在中国患者中的有效性。我们的研究结果反映了在2017年之前提高中国药物可及性的迫切需要，并强调将创新生物制剂纳入中国医疗保险计划可以减轻患者的经济负担并改善mCRC的管理。
Objectives: To describe direct medical costs associated with each line of treatment among metastatic colorectal cancer (mCRC) patients in China. Methods: Electronic medical records between 2011 and 2016 were extracted from 12 tertiary hospitals in China for adult patients who initiated third-line treatment at least nine months before the end of data collection. Direct medical costs included costs of wards, diagnostic tests, surgical procedures, special materials, drugs and others. Costs were assessed by line of treatment, and drug costs were further breakdown for patients receiving chemotherapy alone and those receiving chemo- and biologics-combined therapy. Results: Of the 404 mCRC patients, the mean age was 55 years old and 62% were male. Oxaliplatin- and irinotecan-based regimens dominated first- and second-line treatment, respectively (44 and 37%). From first- to second- to third-line, the proportion of patients receiving targeted biologics increased from 18% at first-line and 12% at second-line to 34% at third-line; median number of treatment cycles reduced from 6 to 4 and to 2. The corresponding mean direct medical costs per person per cycle increased from $2,514 to $2,678 to $5,121. Mean drug costs per cycle increased from $2,314 to $2,673 to $4,316 among patients receiving chemotherapy alone and from $3,245 to $2,717 to $6,533 among patients receiving chemo- and biologics-combined therapy. Conclusions: Before 2017, mCRC patients in China did not receive the maximum benefits of precision medicine breakthroughs. Reduced treatment cycles and increased costs per cycle from first- to third-line suggested poor healthcare resource utilization. With earlier initiation and more treatment cycles, targeted biologics may better demonstrate their effectiveness among Chinese patients. Our findings reflected the urgent need to increase drug accessibility in China before 2017 and underscore that including innovative biologics into Chinese health insurance plans can reduce patients' economic burden and improve the management of mCRC.